Student performance in a flipped classroom dental anatomy course.

PURPOSE: The purpose of this study was to assess dental student learning in a dental anatomy module between traditional lecture and flipped classroom cohorts. METHODS: Two cohorts of predoctoral dental students (N = 70 within each cohort) participated in a dental anatomy module within an Introduction to the Dental Patient (IDP) course ([traditional/lecture cohort: academic year (AY) 2012, 2013] and [flipped classroom cohort: AY 2014, 2015]). For the dental anatomy module, both cohorts were evaluated on pre-clinical tooth waxing exercises immediately after each of five lectures and tooth identification after all lectures were given. Additionally, the cohorts' performance on the overall IDP course examination was compared. RESULTS: The flipped classroom cohort had statistically significant higher waxing scores (dental anatomy module) than students in the traditional classroom. There was no statistically significant difference for tooth identification scores and the overall IDP course examination between the traditional vs flipped approach cohorts. This is due to the latter two assessments conducted at the end of the course gave all students enough time to review the lecture content prior to the assessment resulting in similar scores for both cohorts. CONCLUSION: The flipped classroom cohort promoted students' individual learning and resulted in improved students' performance on immediate evaluation but not on the end of the course evaluation. Redesign of courses to include a new pedagogical approach should be carefully implemented and evaluated for student's educational success.

An evaluation of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury: input from the international community.

STUDY DESIGN: Interactive workshops with a presurvey-postsurvey. OBJECTIVES: To describe a series of workshops held at international meetings to inform the spinal cord injury (SCI) community about the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury (ISAFSCI) and to obtain feedback on both the workshop and the ISAFSCI assessment. SETTING: Three international conferences of SCI practitioners in Toronto, Las Vegas and Vancouver held between 2012 and 2013. METHODS: The workshops included an overview of the ISAFSCI, sharing experiences using it in clinical practice and interactive cases illustrating how to complete the scoring. A presurvey-postsurvey was administered to obtain feedback on the workshops and the ISAFSCI assessment. RESULTS: One hundred and fourteen participants completed the workshop surveys and 96% (109/114) completed both presurvey and postsurvey. Prior to the workshop, 41% (47/114) of those who had completed the survey reported assessing autonomic function in their practice, and of those, 53% (25/47) reported using the ISAFSCI. After the workshop, 74% (84/114) of participants reported that the case studies were helpful, and 57% (65/114) reported that they wanted to start or continue to use the ISAFSCI in their clinical practice. Suggestions for improving the ISAFSCI included providing further areas to consider when performing the assessment, addressing ambiguity of terms and reporting foreseeable implementation challenges. CONCLUSION: Results from this workshop suggest that more work is needed to inform the SCI community on the ISAFSCI assessment and to further clarify its language. Results from this study will inform future revisions to the ISAFSCI.

Development and validation of a computerized algorithm for International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI).

STUDY DESIGN: Validation study. OBJECTIVES: To describe the development and validation of a computerized application of the international standards for neurological classification of spinal cord injury (ISNCSCI). SETTING: Data from acute and rehabilitation care. METHODS: The Rick Hansen Institute-ISNCSCI Algorithm (RHI-ISNCSCI Algorithm) was developed based on the 2011 version of the ISNCSCI and the 2013 version of the worksheet. International experts developed the design and logic with a focus on usability and features to standardize the correct classification of challenging cases. A five-phased process was used to develop and validate the algorithm. Discrepancies between the clinician-derived and algorithm-calculated results were reconciled. RESULTS: Phase one of the validation used 48 cases to develop the logic. Phase three used these and 15 additional cases for further logic development to classify cases with 'Not testable' values. For logic testing in phases two and four, 351 and 1998 cases from the Rick Hansen SCI Registry (RHSCIR), respectively, were used. Of 23 and 286 discrepant cases identified in phases two and four, 2 and 6 cases resulted in changes to the algorithm. Cross-validation of the algorithm in phase five using 108 new RHSCIR cases did not identify the need for any further changes, as all discrepancies were due to clinician errors. The web-based application and the algorithm code are freely available at www.isncscialgorithm.com. CONCLUSION: The RHI-ISNCSCI Algorithm provides a standardized method to accurately derive the level and severity of SCI from the raw data of the ISNCSCI examination. The web interface assists in maximizing usability while minimizing the impact of human error in classifying SCI. SPONSORSHIP: This study is sponsored by the Rick Hansen Institute and supported by funding from Health Canada and Western Economic Diversification Canada.

Efficacy and safety of a lindane 1% treatment regimen for scabies, confirmed by dermoscopy-guided skin scraping with microscopic examination.

BACKGROUND: This is the first study investigating scabies treatment since 1992 to involve examination of patients with microscopically confirmed scabies. AIM: To assess the efficacy of 1% lindane cream in treating microscopically confirmed scabies, and to determine the utility of dermoscopy-guided skin scraping with microscopic examination (DSGSS-ME) in evaluating the efficacy of scabies treatment. METHODS: This retrospective study analysed patients treated for scabies between January 2012 and December 2013. From the hospital database, 287 cases of scabies were identified and 50 were enrolled in the study. Patients were treated with 1% lindane cream twice weekly (days 0 and 1) and were evaluated with DSGSS-ME on day 7. Treatment and evaluations were repeated once weekly until a negative DSGSS-ME result was obtained. RESULTS: The cumulative efficacy of lindane 1% cream was 40% (20/50) after 1 week, 88% (44/50) after 2 weeks and 98% (49/50) after 3 weeks of treatment. There was a statistically significant difference between the 1- and 2-week (P = 0.03), and 1- and 3-week (P = 0.02) treatments. A total of 90 post-treatment DSGSS-MEs were performed, with a sensitivity of 97.3% (95% CI 85.8-99.9) and a negative predictive value of 98.2% (95% CI 90.1-100). Specificity and positive predictive value were 100%, as this procedure cannot yield false-positive results, because it relies on finding mites, eggs or faeces. CONCLUSIONS: We suggest that a twice-weekly schedule (on consecutive days) of 1% lindane treatment lasting at least 2 weeks is required to clear scabies. DSGSS-ME appears to be a good method to evaluate the efficacy of scabies treatment. This study introduces a safe and effective method to treat scabies, and to accurately monitor infestation status in patients.

Cortical thickness and hippocampal shape in pure vascular mild cognitive impairment and dementia of subcortical type.

BACKGROUND AND PURPOSE: The progression pattern of brain structural changes in patients with isolated cerebrovascular disease (CVD) remains unclear. To investigate the role of isolated CVD in cognitive impairment patients, patterns of cortical thinning and hippocampal atrophy in pure subcortical vascular mild cognitive impairment (svMCI) and pure subcortical vascular dementia (SVaD) patients were characterized. METHODS: Forty-five patients with svMCI and 46 patients with SVaD who were negative on Pittsburgh compound B (PiB) positron emission tomography imaging and 75 individuals with normal cognition (NC) were recruited. RESULTS: Compared with NC, patients with PiB(-) svMCI exhibited frontal, language and retrieval type memory dysfunctions, which in patients with PiB(-) SVaD were further impaired and accompanied by visuospatial and recognition memory dysfunctions. Compared with NC, patients with PiB(-) svMCI exhibited cortical thinning in the frontal, perisylvian, basal temporal and posterior cingulate regions. This atrophy was more prominent and extended further toward the lateral parietal and medial temporal regions in patients with PiB(-) SVaD. Compared with NC subjects, patients with PiB(-) svMCI exhibited hippocampal shape deformities in the lateral body, whilst patients with PiB(-) SVaD exhibited additional deformities within the lateral head and inferior body. CONCLUSIONS: Our findings suggest that patients with CVD in the absence of Alzheimer's disease pathology can be demented, showing cognitive impairment in multiple domains, which is consistent with the topography of cortical thinning and hippocampal shape deformity.

Knowledge translation and implementation in spinal cord injury: a systematic review.

OBJECTIVE: To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. METHODS: MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. RESULTS: A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. CONCLUSION: The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.

Reliability of the spine adverse events severity system (SAVES) for individuals with traumatic spinal cord injury.

STUDY DESIGN: Test-retest analysis. OBJECTIVES: To determine the intra- and inter-rater reliability of the Spine Adverse Events Severity System for Spinal Cord Injury (SAVES-SCI) in patients with traumatic SCI. SETTING: Quaternary care spine program in Vancouver, Canada. METHODS: Ten hypothetical patient cases were developed. The cases were completed by 10 raters (seven physicians, one nurse, one physiotherapist and one researcher) who were asked to identify and grade the severity of adverse events using SAVES-SCI twice with 1-week interval. Intra- and inter-rater reliability were calculated using kappa statistics and intraclass correlation coefficients (ICC). RESULTS: Intra-rater reliability for both identifying and grading AEs were high with all AEs (kappa greater than 0.6) except for bone implant, diathermy burn, massive blood loss, myocardial infarction, neurological deterioration, pressure ulcer, return to operating room and tracheostomy requirement. The inter-rater reliability measured with ICC were all above 0.6 for identifying and grading intraoperative, pre and postoperative AEs and consequences of SCI. CONCLUSIONS: The SAVES-SCI demonstrated acceptable intra-and inter-rater reliability for a majority of the AEs. Further clarification and definition of some of the AEs as well as provision of sample training cases for clinicians would assist in reducing measurement errors. The SAVES-SCI is a useful tool to assess and capture AEs in patients with acute traumatic SCI.

Evaluation of a pilot Pressure Ulcer Prevention Initiative (PUPI) for patients with traumatic spinal cord injury.

OBJECTIVE: The purpose of this study was to determine whether implementation of a Pressure Ulcer Prevention Initiative (PUPI) changed the assessment and treatment of patients with a traumatic spinal cord injury (SCI) in an acute care setting, and improved patient outcomes. METHOD: The success of implementation was evaluated by examining the percentage of patients with completed occupational therapist (OT) skin care assessments and prescriptions for therapeutic support surfaces (TSS; i.e., mattresses) before implementation (historical, cohort 1) and after implementation (experimental, cohort 2). Patient outcomes were evaluated by examining changes in PU incidence, severity, timing and recurrence, as well as PU prevalence and satisfaction with life in the community. RESULTS: Final analysis included 70 patients in cohort 1 and 73 in cohort 2. OT skin care assessment documentation (31% to 60%; p<0.001) and TSS prescriptions (31% to 60%; p=0.02) significantly increased following the implementation. The PU incidence based on patient charts (both nursing and OT assessments) did not increase significantly (26% to 36%; p=0.2). However, documented PU incidence according to OT assessments showed a substantial increase (14% to 33%; p=0.002). No effect of the PUPI was seen on immediate or long-term patient outcomes during the study period. CONCLUSION: PUPI was successful in changing clinical practice in PU prevention but no statistically significant improvements in PU-related patient outcomes were demonstrated. Results from this study identified facilitators and barriers to implementation and highlighted the complexity and difficulty of instituting effective preventative or therapeutic interventions for this population in an acute care setting. This information will assist with refinements of the PUPI and inform similar future initiatives.

Serum 1,5-anhydroglucitol is associated with diabetic retinopathy in Type 2 diabetes.

AIMS: To determine whether there is a relationship between 1,5-anhydroglucitol (1,5-AG), a marker of postprandial hyperglycaemia and glycaemic variability, and the presence of diabetic retinopathy and albuminuria in patients with Type 2 diabetes. METHODS: Five hundred and sixty-seven patients with Type 2 diabetes (serum creatinine < 133 µmol/l), who were enrolled in the Seoul Metro-City Diabetes Prevention Program (SMC-DPP), were cross-sectionally assessed by multivariate logistic regression analysis. RESULTS: After controlling for age, sex, binary HbA(1c) levels, duration of diabetes, triglyceride, systolic blood pressure, smoking status, history of hypertension and dyslipidaemia, and the use of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker medication, the odds ratios (95% CI) of diabetic retinopathy were 2.86 (1.12-7.25) for the first (lowest) quartile of 1,5-anhydroglucitol, 2.87 (1.25-6.61) for the second quartile and 0.88 (0.35-2.22) for the third quartile compared with the fourth quartile (P for trend = 0.010). Conversely, the associations between 1,5-anhydroglucitol and clinical albuminuria were non-significant after adjustment. Subjects with low 1,5-anhydroglucitol (< 10.0 µg/ml) were more likely to experience diabetic retinopathy than those with high 1,5-anhydroglucitol (≥ 10.0 µg/ml) under moderate glucose control (HbA(1c) < 8%, 64 mmol/mol) and there were no significant differences in the prevalence of diabetic retinopathy between the subgroup with HbA(1c) < 8% (64 mmol/mol) and low 1,5-anhydroglucitol and the subgroup with HbA(1c) ≥ 8% (64 mmol/mol). CONCLUSIONS: 1,5-Anhydroglucitol levels show close associations with diabetic retinopathy, especially among patients under moderate glucose control, but not with albuminuria. These results suggest that 1,5-anhydroglucitol might be a complementary marker for targeting higher risk group.

The role of serum adipocyte fatty acid-binding protein on the development of metabolic syndrome is independent of pro-inflammatory cytokines.

BACKGROUND AND AIM: Adipocyte fatty acid-binding protein (FABP4) is abundantly expressed in adipocytes and plays a role in glucose homeostasis. We analysed the relationship between serum FABP4 levels and the progression of metabolic syndrome in healthy adults. METHODS AND RESULTS: A total of 465 subjects were selected from participants in a medical check-up programme at a Health Promotion Center. Baseline serum FABP4 levels were measured, and the subjects were evaluated for the presence of metabolic syndrome (MetS) according to the recommendations of the American Heart Association/National Heart, Lung, and Blood Institute. The subjects were re-evaluated 4 years later. Baseline FABP4 concentrations were significantly higher in subjects with MetS than in those without MetS (P<0.001). At the 4-year follow-up, subjects in the highest FABP4 tertile at baseline exhibited higher values for body mass index, fat mass and percent body fat, as well as blood pressure, fasting glucose, total cholesterol, triglycerides, low-density lipoprotein (LDL)-cholesterol, insulin, homeostasis model assessment of insulin resistance, monocyte chemoattractant protein-1 and tumor necrosis factor-α levels (all P<0.05). The subjects with higher FABP4 levels had lower HDL-cholesterol concentrations (P<0.05). After adjustment for age, sex, change in percent body fat and baseline values for other metabolic and inflammatory parameters, FABP4 levels at baseline were shown to be strongly associated with the development of MetS by year 4 (odds ratio (OR), 5.75; 95% confidence interval (CI), 2.71-12.23 for highest tertile vs. lowest tertile, P<0.001) CONCLUSION: Baseline serum FABP4 levels appear to be a significant predictor for the future development of MetS, independent of pro-inflammatory cytokines.

Autism-linked gene FoxP1 selectively regulates the cultural transmission of learned vocalizations.

Autism spectrum disorders (ASDs) are characterized by impaired learning of social skills and language. Memories of how parents and other social models behave are used to guide behavioral learning. How ASD-linked genes affect the intertwined aspects of observational learning and behavioral imitation is not known. Here, we examine how disrupted expression of the ASD gene FOXP1, which causes severe impairments in speech and language learning, affects the cultural transmission of birdsong between adult and juvenile zebra finches. FoxP1 is widely expressed in striatal-projecting forebrain mirror neurons. Knockdown of FoxP1 in this circuit prevents juvenile birds from forming memories of an adult song model but does not interrupt learning how to vocally imitate a previously memorized song. This selective learning deficit is associated with potent disruptions to experience-dependent structural and synaptic plasticity in mirror neurons. Thus, FoxP1 regulates the ability to form memories essential to the cultural transmission of behavior.

Predicting dental school performance based on prior dental experience and exposure.

PURPOSE: The purpose of this study was to evaluate whether the variables of students with prior dental assisting experience and students with a parent who is a dentist can be used as predictors of students' pre-clinical and clinical course performance in dental school. MATERIALS AND METHODS: The study population consisted of a cohort of 159 students in the Harvard School of Dental Medicine (HSDM) DMD graduation classes of 2001-2005. Data were collected via self-report using students' applications for admission to the HSDM DMD programme on which students provided information regarding whether they had prior dental assisting experience, including the type and duration of the experience and whether one or both of their parents were dentists. Data on the students' undergraduate science grade point average, Dental Admission Test academic average, Perceptual Ability Test (PAT) score, NBDE Part I and HSDM course grades (three pre-clinical and five clinical assessment categories) were collected from the Office of the Registrar. The pre-clinical categories included the first Oral Comprehensive Exam and the first two classes of the pre-clinical portion of the dental school, Treatment of Active Disease (TxAD) and Restorative Treatment (RTx). The clinical categories included the second Oral Comprehensive Exam and the cumulative grades received for the clinical procedures performed during the third and fourth years in the fields of Endodontics, Operative Dentistry, Periodontics and Prosthodontics. Descriptive and bivariate statistical analyses were performed and included in a multiple logistic regression model. RESULTS: The results revealed that for the variable of prior dental-assisting experience, no statistically significant differences were noted in the pre-clinical and clinical assessment categories. However, students who had any amount of assisting experience were 2.2 times more likely to earn a grade of honours in TxAD compared with students who did not have assisting experience (P = 0.05). Students with a parent who was a dentist performed better only in Operative Dentistry clinical assessment compared with students without a dentist parent (P < 0.05). CONCLUSIONS: Information on prior dental-assisting experience and having a parent who is a dentist have minimal merits for use as predictive agents based on these findings. Dental school admissions committees should continue to review a full spectrum of variables and ensure an applicant's true interest and motivation to pursue a career in dentistry.

Clinical Experience of 1-Minute Brain MRI Using a Multicontrast EPI Sequence in a Different Scan Environment.

BACKGROUND AND PURPOSE: The long scan time of MR imaging is a major drawback limiting its clinical use in neuroimaging; therefore, we aimed to investigate the clinical feasibility of a 1-minute full-brain MR imaging using a multicontrast EPI sequence on a different MR imaging scanner than the ones previously reported. MATERIALS AND METHODS: We retrospectively reviewed the records of 146 patients who underwent a multicontrast EPI sequence, including T1-FLAIR, T2-FLAIR, T2WI, DWI, and T2*WI sequences. Two attending neuroradiologists assessed the image quality of each sequence to compare the multicontrast EPI sequence with routine MR imaging protocols. We used the Wilcoxon signed rank test and McNemar test to compare the 2 MR imaging protocols. RESULTS: The multicontrast EPI sequence generally showed sufficient image quality of >2 points using a 4-point assessment scale. Regarding image quality and susceptibility artifacts, there was no significant difference between the multicontrast EPI sequence DWI and routine DWI (P > .05), attesting to noninferiority of the multicontrast EPI, whereas there were significant differences in the other 4 sequences between the 2 MR imaging protocols. CONCLUSIONS: The multicontrast EPI sequence showed sufficient image quality for clinical use with a shorter scan time; however, it was limited by inferior image quality and frequent susceptibility artifacts compared with routine brain MR imaging. Therefore, the multicontrast EPI sequence cannot completely replace the routine MR imaging protocol at present; however, it may be a feasible option in specific clinical situations such as screening, time-critical diseases or for use with patients prone to motion.

Effect of ABCA1 variant on atherogenic dyslipidaemia in patients with Type 2 diabetes treated with rosiglitazone.

AIMS: To investigate the effect of two common ATP-binding cassette transporter 1 (ABCA1) polymorphisms (rs4149263 and rs2020927) on atherogenic dyslipidaemia in Korean Type 2 diabetic patients who were treated with rosiglitazone. PATIENTS AND METHODS: Two hundred and fifty-six patients with Type 2 diabetes who had never previously received peroxisome proliferator-activated receptor gamma (PPAR-gamma) agonists or lipid-lowering treatment were treated with 4 mg of rosiglitazone daily for 12 weeks without any adjustment to their glucose-lowering regimen. The primary outcome was the change in atherogenic index of plasma (AIP), calculated as log [triglyceride (mmol/l)/high-density lipoprotein cholesterol (mmol/l)], before and after rosiglitazone treatment. The effect of rosiglitazone on the change in AIP was compared across the ABCA1 single nucleotide polymorphisms (SNPs) rs41429263 and rs2020927. RESULTS: Before adjustment, the change in AIP at 12 weeks was significantly different across the rs4149263 genotypes [median (interquartile range): -0.05 (-0.21, 0.09) for TT; 0.02 (-0.09, 0.17) for TC; and 0.11 (0.03, 0.25) for CC; P = 0.003], but not across the rs2020927 [-0.04 (-0.18, 0.10) for TT; 0.03 (-0.17, 0.15) for TC; and -0.03 (-0.13, 0.10) for CC; P = 0.401]. After controlling for age, gender and duration of diabetes, the presence of the C-allele was significantly associated with an increase in AIP by 0.13 [95% confidence interval (CI), 0.04-0.21; P = 0.003]. This association did not change significantly when body mass index and pretreatment metabolic parameters were additionally controlled for (the change in AIP: 0.14; 95% CI, 0.04-0.24; P = 0.007). CONCLUSIONS: The ABCA1 SNP rs4149263 may be associated with the change in atherogenic lipid profile in Type 2 diabetes treated with rosiglitazone.

Molecular cloning and functional characterization of a sucrose isomerase (isomaltulose synthase) gene from Enterobacter sp. FMB-1.

AIMS: Isomaltulose (palatinose) is a slowly digestible sucrose isomer that can reduce both the glycemic and insulinemic response to foods. The aim of this study was to clone and express a sucrose isomerase (SIase) gene and characterize the protein that is responsible for the production of isomaltulose in the micro-organism Enterobacter sp. FMB-1. METHODS AND RESULTS: A cosmid clone containing c. 6 kbp region encoding an SIase gene was identified. The 5969-bp chromosomal DNA fragment covering the SIase (esi) gene in Enterobacter sp. FMB-1 was sequenced. Although this DNA fragment contained several open reading frames other than esi, only the presence of esi was sufficient to produce isomaltulose in recombinant Escherichia coli. The esi gene was expressed in E. coli, leading to the characterization of its SIase activity. CONCLUSIONS: The Enterobacter sp. FMB-1 esi gene was successfully cloned and expressed in E. coli. This gene encoded a functional SIase that produced isomaltulose from sucrose. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first molecular analysis of an SIase gene in an Enterobacter strain. The functional expression of the Enterobacter sp. FMB-1 esi gene in E. coli offers an alternative choice for the industrial production of isomaltulose.

Direct comparison of optical frequency combs using a comb-injection-lock technique.

This paper demonstrates a direct comparison of optical frequency combs (OFCs) with different repetition rates without a stable intermediate laser using a single-mode comb-injection-lock technique. Two OFCs based on Ti:Sapphire mode-locked lasers were compared utilizing a single-mode diode laser for the selection and the amplification of one mode of an OFC by comb-injection, which makes the direct comb comparison possible. The frequencies of the two combs were found to agree within 0.019 Hz at 352 THz with the uncertainty of 0.25 Hz (7.1 x 10(-16) ). This is one of the best results among the comparisons of combs referenced to a microwave frequency. This technique simplifies the comb comparison utilities and can be applied even when repetition rates differ.

Analysis of Pre-transplant Resuscitation Factors Influencing Immediate Graft Function After Deceased Donor Kidney Transplantation.

BACKGROUND: The management of a deceased donor in the intensive care unit before organ transplantation is important for the outcome of the recipient. Herein, we analyze the pre-transplant resuscitation factors managed before procurement that could influence graft function immediately after deceased-donor kidney transplantation (DDKT). METHODS: A total of 271 DDKTs performed at Seoul St. Mary's Hospital, Korea, from January 2009 to March 2016 were reviewed. We divided the patients into a delayed graft function (DGF) group and a non-DGF group, and compared postoperative outcomes between the 2 groups. We also analyzed the predisposing factors of DGF using multivariate analysis. RESULTS: A total of 36 cases developed DGF while 235 patients did not, and the demographic characteristics of the recipients in the two groups had no significant difference. Of the pre-transplant resuscitation factors, preoperative polyuria, the maximal levels of serum sodium and BUN, and transfer times were significantly higher in the DGF group (P < .001). In a multivariable analysis, preoperative polyuria (odds ratio 4.835, P = .036), elevated preoperative level of sodium (odds ratio 1.227, P = .001), and extended transfer times (odds ratio 1.001, P < .001) were the independent risk factors of the donor in pre-transplant resuscitation management associated with DGF. CONCLUSIONS: Polyuria, high levels of sodium before procurement, and prolonged transfer times are independent risk factors for DGF after a DDKT. Active intervention and early implementation of the intensivist can help in managing these factors effectively and thus ultimately improve graft function.

Appropriate Amount of Regular Exercise Is Associated with a Reduced Mortality Risk.

PURPOSE: This study aimed at investigating whether there is a continuous dose-response relationship between the amount of physical activity (PA) and longevity benefit. METHODS: We evaluated the records of 23,257,723 Koreans age ≥20 yr who had undergone one biennial medical evaluation by the National Health Insurance Corporation. Participants with ≥20 min of vigorous or ≥30 min of moderate PA or walking were stratified into four groups: 0 d·wk; 1-3 d·wk; 4 to 5 d·wk; and 6-7 d·wk. After calculating total metabolic equivalent task-hours per week (MET·h·wk), we created eight categories of MET-hours per week (0, 0.1-4.9, 5.0-9.9, 10.0-14.9, 15.0-19.9, 20.0-24.9, 25.0-29.9, and ≥30.0). Multivariate Cox proportional hazard analyses were performed. RESULTS: A reverse J-shaped risk curve was observed, with the lowest mortality risk in the participants exercising 4 to 5 d·wk (reference). Participants who did not exercise at all and those who exercised with a PA frequency of 1 to 3 d·wk or 6 to 7 d·wk showed a significantly increased mortality risk compared with the reference group. When we repeated the Cox analysis among the 8 MET·h·wk categories with the participants reporting 20.0 to 24.9 MET·h·wk of PA as the reference group, we found that those with physical inactivity and 25.0-29.9 or ≥30.0 MET·h·wk of PA showed a higher mortality risk than the reference group. These relationships were persistently observed after adjustment for confounders. CONCLUSIONS: An appropriate amount of regular exercise in each specific type of PA was associated with the lowest risk of mortality. The inactive participants showed an increased mortality risk, and daily PA did not show any additional benefit in the mortality risk.

High tuberculosis transmission rate in children with nursery exposure to undetected pulmonary tuberculosis.

SETTING: Nursery for newborns in Busan, Republic of Korea. OBJECTIVE: To evaluate tuberculosis (TB) transmission from a health care worker with active pulmonary TB to neonatal contacts. DESIGN: For the first investigation, infants who had been in the nursery 3 months before the index patient was diagnosed with pulmonary TB were enrolled. After a child who had stayed in the nursery 10 months before the diagnosis of the index patient was diagnosed with tuberculous meningitis, a second contact investigation was conducted. RESULTS: Respectively 315 and 1334 children participated in the first and second investigations. The mean age of the contacts was 66.3 days; the rate of latent tuberculous infection (LTBI) at the first investigation was 42.5% (134/315). Only one infant had an abnormal chest X-ray, and was thought to have pulmonary TB. In the second investigation, the mean age of the participants was 17.6 months. The proportion of children with LTBI was 18.7% (249/1334). CONCLUSIONS: The LTBI rate in the present study was much higher than that estimated from other contact investigations. To minimise the risk of nosocomial TB transmission to neonates, screening and management of TB in health care workers should be strengthened.

Coherent multi-frequency optical source generation using a femto-second laser and its application for coherent population trapping.

We present a coherent multi-frequency source generated from a mode-locked femto-second laser. The key concept for the coherent multi-frequency source generation is using the mode-locked femto-second laser as many continuous wave (CW) optical sources. We simultaneously selected and amplified the desired modes of the optical frequency comb using femto-second laser injection-locking (FSLIL). Using two coherent sources generated by the mode-locked femto-second laser, we have demonstrated a coherent spectroscopy in a Lambda-type system of the Cs D2 line. The proposed coherent multi-frequency source generation technique will be a useful technique for optical frequency standards based on multi-photon schemes.